Teaching Thinking and Writing to First Year Nurses
Marian Butler (Teaching and Learning Support Services, QUT, Brisbane) and Diane
Collins (School of Nursing, QUT, Brisbane)
Student's ability to write well and to think critically is essential for both academic success
and future employment. For these reasons staff have been concerned to improve the
quality of student writing in the School of Nursing.. A series of lectures on thinking and
writing was therefore introduced into Nursing 1 three years ago. This paper outlines the
aims of the program and how it evolved as well as discussing the benefits and difficulties
that were experienced in implementing it. Staff and student evaluations of the program
are discussed along with recommendations for changes.
Introduction
This learning support strategy occurred as a response to student needs and staff concerns
about the quality of academic writing in the School of Nursing. Typically, first year
nursing classes consist of large numbers of mature age students, many of whom lack
confidence in their academic skills because they have not studied for some years.
Additionally there are numbers of recent school leavers who do not always have strong
academic skills, though they are not necessarily lacking in confidence. The decision to
include compulsory writing lectures into Nursing 1 (a compulsory, first year subject) was
made in an effort to give students the skills necessary for academic writing 'up front'
rather than waiting for them to acquire these skills through trial and error (Butler, 1996).
Additionally, staff felt that it was important for students to realise that good writing and
critical thinking skills are essential in nursing practice (Craven & Hirnle, 2000; SteinParbury, 1995; Nolan, 1995; Pease,1997).
The program was developed collaboratively between School of Nursing staff and
Teaching and Learning Development Unit (TALDU) staff.
Rationale
The program is based on four principles. Firstly, it is based on the belief that academic
writing is different in style, complexity and structure from school writing (Bate and
Sharp, 1996) and therefore needs to be taught. Secondly, it is based on a metacognitive
framework which promotes the view that students need to be guided through the process
of writing an assignment by explicitly focussing on the questioning and thinking that is
necessary, rather than simply being told what academic writing should look like. This
approach is designed to give students insight into the ways that competent learners learn
and to give them the opportunity to reflect on their own learning strategies and to trial
and evaluate new strategies (Brown & Palincar, 1982; Borkowski, Carr & Pressley, 1987
and Jacobson, 1998). Thus the focus is on the thinking process that underpins successful
writing, rather than on structural aspects alone. The third principle is to encourage
students to adopt a 'deep' approach to assignment writing rather than a superficial 'cut and
paste' approach. Students who adopt a surface approach tend to see assignments as
assessment tasks, rather than as opportunities for reflection and learning in depth on a
topic (Biggs, 1991). Finally, the program is based on the view that in order for students
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to develop a deep approach to writing, staff need to both tell students about this approach,
as well as to engage them in tasks which give them experience and practice with it
(Biggs, 1999).
Aims of the writing program
The program was designed to target thee groups of generic skills and to teach them in the
context of a Nursing unit so that it would be relevant to students and easy for them to
generalise the principles to their discipline. The decision to include it into the Nursing
program rather than adding it on to the program was based on the recommendations of
the Higher Education Council report on Achieving Quality (1992).
The three groups of generic skills focussed on were those identified by Clanchy and
Ballard (1995) as the three that distinctively characterise univeristy education, namely:
thinking and reasoning
researching (looking for and managing information)
communicating ideas (through writing)
These groups of generic skills were taught by:
 outlining a clear process that students could use to research, plan and write
assignments.
 clarifying what is involved in critical reading/thinking.
 making clear links between the quality of planning and writing.
 clarifying and identifying the features of the genre used in Nursing 1.
 alerting students to referencing and editing issues.
 enabling students to prepare and write exam questions.
History
The first writing program was initiated in 1997. At this time the students were given
seven lectures on academic writing with no follow up in tutorials. Each writing lecture
took up the first hour of the two hour lecture slot, with the second hour being devoted to
Nursing content. Students were encouraged to buy a text that supplemented the writing
lectures. The assessment for the unit consisted of two 1500 word assignments and an
exam on the nursing content of the course. The information about writing was not
assessed directly. In order to assess the quality of the writing component of the unit,
students were asked to evaluate this component of the course through a student
evaluation questionnaire. Student ratings on the usefulness of the course were mostly
positive, but we were aware that at least half of the students in the class had chosen not to
come to the classes because they felt they did not need assistance with assignment
writing. Staff felt that the students who were absenting themselves from the classes were
not necessarily competent assignment writers. For this reason changes were made the
following year.
In 1998 an attempt was made to achieve greater integration between the writing material
and the nursing content. Thus students were given 8 lectures, plus articles to read which
were used in the lectures and tutorials to demonstrate some of the concepts that had been
taught in lectures, for example, an article that had relevance to nursing practice was used
to demonstrate how to make a concept map. Content about the writing process and skills
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from the writing lectures were assessed in the end of semester exam and the assignment
load was reduced to one 1500 word essay. Student evaluations were again reasonably
positive, but it was evident from the exam responses and attendance at classes and
tutorials that some students had still not attended the writing lectures.
In order to try to engage more students and to give everybody the opportunity to develop
their writing skills, a tutorial package was introduced in 1999 to accompany the lecture
material. This package required students to read articles and apply principles that had
been taught in the writing lectures. Thus a stronger link between the Nursing 1 content
and the writing content was made. Assessment was through one 1500 word assignment,
completion of the tutorial package, a problem solving computer based exercise and an
exam. Students were required to complete tasks in the tutorial package during and
between tutorials. This was handed in and students were given a completion mark for it.
Thus the students who chose not to go to lectures still had the possibility of reading the
text and participating in the tutorials.
The present program:
This year the same tutorial package is being used, with students receiving marks for their
participation in it. There have been some minor changes to the lectures, and the
assignment topics and assessment criteria have been clarified. Additionally this year
during the second lecture, students were given a brief essay to write in response to two
pages of research findings on a health related topic. They were allowed thirty minutes in
class to work on the task and were allowed to complete the essay at home. No marks
were allocated for this work. The purpose of the task was for students to demonstrate
their understanding of the research and to discuss it in a synthesised and critical way.
During the third lecture, students were shown a poor response and an excellent response.
The poor response was to show students how to avoid common errors, while the excellent
response was to demonstrate the style of writing required of them at university. Students
were asked to evaluate their own work on a list of assessment criteria, by comparing it
with the answers we had shown them in the lecture. This was to encourage them to
reflect on the aspects of their writing that might need improvement. Additionally, it was
designed to show them that there is more to learn about academic writing and that they do
need to attend the writing lectures and tutorials.
The current lecture program consists of the following topics, with a tutorial exercise on
each week's content:
Week
1
2
3
4
5
6
7
8
Lecture content
The writing process
Efficient reading strategies
Higher level thinking
Academic style and genre
Concept mapping
Structure, linking, theme
Referencing and editing
Preparing and Writing exams
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Each lecture lasts approximately one hour and is delivered to about 300 students in a
large lecture theatre. The writing part of the one hour tutorial slot lasts about 30 minutes.
Outcomes
Student feedback
The 265 students in Nursing 1 in 1999 were asked to evaluate the writing component of
the Nursing 1 lectures using two evaluation tools. Firstly, there were three questions on
the Student Evaluation of Unit (SEU) which were related to the material covered in the
writing component. Secondly, students were asked to evaluate the writing component of
the course using a questionnaire that was separate from the regular SEU instrument.
There were three statements on the Student Evaluation of Unit questionnaire that related
to the writing component. These were:
1. I have developed my written communication skills in this unit
2. The unit helps me to learn how to access, retrieve, evaluate and use relevant
information
3. The tutorial/seminar content is well organised and is taught in appropriate ways
Surveys were returned by 160 students. In response to question one, 55% of students
agreed that they had developed their writing skills and 18% strongly agreed that they had
developed their writing skills. In response to question two, 58% agreed with the
statement and 20% strongly agreed with it. Responses to the third question were similar
with 55% agreeing
with the statement and 18% strongly agreeing with it.
%
60
50
40
%
60
30
50
20
40
10
30
0
1
20
2
3
4
5
Ratings on Qn 3
10
0
1
%
2
Ratings
on3 Qn 14
5
60
50
40
30
20
10
0
1
2
3
4
5
Ratings on Qn 2
4
Student responses to the questionnaire specifically used to evaluate the writing
component revealed similar results. On this questionnaire students were asked to evaluate
the writing component on usefulness and applicability using a five point scale. Forty
eight students responded to the survey. The majority of students found the information
about writing useful: 21% rated it as moderately useful, 33% found it quite useful and
31% found it very useful. Thus 85% of the students rated it in the moderately useful to
very useful categories (scores of 3, 4 and 5 on the five point scale). Only 14% rated it as
not useful. In terms of applicability, 17% rated the material as not applicable, 30 % rated
it as moderately applicable and 52% rated it as having many applications. Thus 82%
rated it from ‘moderately applicable’ to ‘having many applications’ (scores of 3, 4 and 5
on the five point scale). In addition to ratings, students were asked to comment on why
they had not applied the material if applicable. The most common reason given for lack
of application was that their previous methods worked well. Some students indicated that
even though their old habits were not necessarily effective, it was difficult for them to
break these habits and they were 'too lazy' or simply 'forgot' to apply the new principles.
Students were also asked to comment on the aspects of the writing component that were
most useful to them. Referencing was most often mentioned by students (22 comments)
followed closely by concept mapping (14 comments) and structure, linking and planning
(13 comments).
5
How useful was the information about writing?
%
35
30
25
20
15
10
5
0
1
2
3
4
5
Ratings
How much have you been able to apply this information to your work?
%
35
30
25
20
15
10
5
0
1
2
3
4
5
Ratings
Staff feedback:
Six of the nine tutors who taught the course were interviewed. These staff indicated that
their students had benefited from the writing lectures and accompanying tutorial package.
None of these staff wanted any components of the course dropped and four of them
indicated that student writing had improved since the introduction of the writing
component in 1997. Staff identified critical thinking and concept mapping as the most
difficult concepts for students to grasp and suggested that students might need more
practice in these areas. In response to the question: How actively did the students
participate in the writing activities during the tutorial? Staff indicated that more than
90% of students had been actively involved in classes and had handed in the tutorial
package with almost none of them scoring less than 50% for it. Staff indicated that the
few who were disinterested in the tutorial tasks may have had the ‘wrong mindset’. It is
likely that these students were those who admitted in their written comments that they
had not tried to apply the principles because they either ‘forgot’, were ‘too lazy’ or found
that their old strategies worked well enough for them.
All staff indicated that they too, had learnt from the process themselves. For some, this
learning was related to understanding explicitly concepts that they had known intuitively
or taken for granted before, and other staff indicated that they had learnt more about the
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difficulties and misconceptions students have about writing. One staff member
described how she had started to use concept mapping in her teaching.
Difficulties
Student difficulties
Critical thinking was identified by staff as a major area of difficulty that students still had
to contend with even after they had completed the writing component. It seems likely that
this is a skill that needs to be developed throughout the course and that it is unlikely to
develop in a short period of time. This new, questioning approach (Browne and Keeley,
1981) may require more practice than there is time for in this unit. Students also found
concept mapping difficult. Since this approach requires questioning similar to that
required for critical thinking (Baugh and Mellott, 1998) it is likely that these skills will
develop with further practice over a period of time. However, students will need to be
encouraged to continue practicing this strategy throughout their course. It is likely that
this would best be achieved if concept mapping were built into the structure of later units.
Another difficulty identified by both students and staff was the lack of practical
knowledge of nursing itself in the unit. Although there was a strong relationship between
the writing content and nursing issues, it was felt that students would accept the writing
component better if the articles chosen for tutorial use were more closely linked to
nursing practice. Some students indicated that their expectation of the unit overall was
that it would be more practically based and give them more hands on experience of
‘being a nurse’. Thus they were disappointed when they were taught how to write.
For this reason, the current articles around which the writing is being taught this year are
more practical and less issues based. This has been done to meet student needs for more
‘hands on’ knowledge.
Staff difficulties
Because of time constraints and the fact that most tutors could not attend the writing
lectures, there was concern it would be difficult to maintain a consistent approach to the
writing process across tutors. This was largely overcome by an initial staff meeting
where the approach was outlined to all staff. Consistency was maintained by the use of a
text on the approach and very clearly structured tutorial tasks.
Future directions
The unit is being updated and evaluated each year. A Teaching and Learning Grant was
obtained this year to fund the development of video tapes that make the links between
nursing theory and practice. The first of these is an interview with a post graduate
nursing student who explains the importance of being able to think critically about his
work. He shows how critical thinking relates to best practice and to his ongoing
professional development. This video was made in response to student feedback given
when they evaluated the writing component and the videos in the series represent an
effort to make stronger links between nursing theory and information about writing and
nursing practice.
Additionally, this year, students have been encouraged to email questions/feedback about
how they are progressing during the semester, rather than waiting until the end of the
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semester via evaluation questionnaires. A web page has been designed for Nursing 1 so
that frequently asked questions are available to all students. Students are also
encouraged to make appointments with tutors or the learning advisor to discuss their
writing concerns. More practice with concept mapping and writing in lectures is planned
this year.
Additionally, further research is planned to determine whether students benefit from the
writing component later on in their course. This will involve surveying and interviewing
second and third year students and the staff who teach them.
Conclusion
The program has been generally well received by students and staff. It seems that a
number of issues need to be considered to ensure student participation, such as:
 forging strong links between the writing issues and the practice of the particular
discipline. Students appear more interested in learning about writing this year since
the introduction of the video which emphasised the importance of critical thinking to
nursing practice.
 assessing the writing component at the end of the unit
 including structured tutorial tasks into the program to ensure that students are trialling
the strategies throughout the unit
 ensuring that all members of the teaching team support the program and emphasise
the strategies and approaches that are taught in the lectures in their tutorial classes
 providing a text that students can refer to in addition to the text
 providing lecture notes prior to lectures so that students can take notes selectively
during the lecture.
The program has evolved over the years in response to student and staff feedback. It
seems important that this type of ongoing evaluation is included, and that changes are
made in response to it.
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